Assessing Pain in Children

Managing a patient’s pain adquately is the responsibility of all health care professionals (especially paramedics) and adequate pain relief is the right of all patients, irrespective of their age. Just because a child is too young to tell you that they are in pain does not mean that they do not deserve good analgesia!

So, how do you assess pain in children?

There are a variety of age appropriate pain scoring techniques develloped over the years by paediatricians, paramedics, nurses and allied health care workers.

This is a list of the common age appropriate pain scoring methods that I have come across during my time on road:

1. The face of pain – which depict several faces ranging from happy smiling to severe pain and as a clinician you may ask the child to point to the face that he or she feels most accurately represents how they are feeling.

2. The FLACC pain scale, which looks more at the behaviour of the patient rather than specific numerical pain values. You look at the face and search for grimace, frown, withdrawn, chin quivering or a clenched jaw. Then you look at the legs to see if they are in the normal position, squirming or arched back, rigid or jerking. Look at the activity, lying quietly or squirming. Listen to the cry, moan, wimpers or constant scream. Assess the consolability, is the child consolable or unconsolable? On a FLACC pain scoring chart, individual numbers are related to each behaviour response. In my experience, it is a relatively useful tool for assessing if the pain is small, medium or big.

3. The linear pain scale, where you have a ruller with a numbering system of no pain through to worst possible pain and ask the child to place the ruller where they beleive they sit.

All of these pain scales have some merit, but in my experience, identifying a specific numerical value for a child’s pain is irrelevant (almost as much as it is in assessing an adult’s pain score). At the end of the day, you want to know if they are comfortable or not. If they are uncomfortable, do they want you to try and take the pain away. If I provide analgesia, I want to know if it is making the pain better or worse.

As a paramedic, I look at the visual clues to see if a child appears in a small, medium or large amount of pain. If they can understand the concept, I will ask them if it is a small, medium or big pain and after providing analgesia I will ask only if it is better or worse? I look at the child’s vital signs, which often tell you a lot more than a number ever will.

The following are physiological signs of pain in children:

1. Tachycardia

2. Tachypnoea

3. Raised blood pressure

4.Raise in blood glucose levels.

5. Restlessness

Good health care can only be achieved by adequately providing pain relief to all patients.